MPFracNet:A Deep Learning Algorithm for Metacarpophalangeal Fracture Detection with Varied Difficulties

Due to small size and high occult,metacarpophalangeal fracturediagnosis displays a low accuracy in terms of fracture detection and locationin X-ray images.To efficiently detect metacarpophalangeal fractures on Xrayimages as the second opinion for radiologists,we proposed a novel onestageneural network namedMPFracNet based onRetinaNet.InMPFracNet,a deformable bottleneck block(DBB)was integrated into the bottleneckto better adapt to the geometric variation of the fractures.Furthermore,an integrated feature fusion module(IFFM)was employed to obtain morein-depth semantic and shallow detail features.Specifically,Focal Loss andBalanced L1 Loss were introduced to respectively attenuate the imbalancebetween positive and negative classes and the imbalance between detectionand location tasks.We assessed the proposed model on the test set andachieved an AP of 80.4%for the metacarpophalangeal fracture detection.To estimate the detection performance for fractures with different difficulties,the proposed model was tested on the subsets of metacarpal,phalangeal andtiny fracture test sets and achieved APs of 82.7%,78.5%and 74.9%,respectively.Our proposed framework has state-of-the-art performance for detectingmetacarpophalangeal fractures,which has a strong potential application valuein practical clinical environments.

Isolated dorsal approach for the treatment of neglected volar metacarpophalangeal joint dislocations

Here, we present the clinical and radiological results of three neglected volar metacarpophalangeal dislocations in 2 patients, which were treated with open reductions 10 and 24 mo after the dislocations. There was a mean of a 20°(range 10°-30°) limitation of extension and a 53.3°(range 30°-70°) limitation of flexion preoperatively. Postoperatively, there was no limitation of extension(at 8 and 12 mo) in any of the fingers. In terms of flexion, one finger had full function, one had a 10° and the last one had a 30° limitation of flexion. Two of the fingers presented anesthesia preoperatively, which improved to hypesthesia postoperatively. One finger had hypesthesia, which improved postoperatively. During surgery, a ruptured dorsal capsule was found to have interposed into the joint, making closed reduction impossible. Our experience with these two patients demonstrated that, even in neglected cases, open reduction using an isolated dorsal approach may result in satisfactory clinical andradiological outcomes.

Case Report: Osteochondral Fragment—A Rare Cause of Locked Metacarpophalangeal Joint

We describe the presentation of a patient with sudden, sharp pain associated with a snapping sensation, swelling and pain over the metacarpophalangeal joint (MCPJ) with no history of direct trauma. The finger was held in 30 degrees of flexion and significantly deviated to the ulnar side with loss of extension. A diagnosis of traumatic rupture of the radial sagittal band of the extensor mechanism was made but the cause at exploration was found to be impingement of an osteochondral fracture fragment. This is a rare cause of irreducible loose body ‘locking’ of the metacarpophalangeal joint.

Artfaroplasty with transplantation of autogenous rib perichondrium for reconstruction of metacarpophalangeal joint

Objective To evluate the outcome of arthropiasty with transplantation of autogenous rib perichondrium for reconstruction of the metacarpophalangeal joint. Methods From 1982 to 2000,15 patients undergoing arthropiasty with autogenous rib perichondrium were analyzed retrospectively. The pain, range of motion and stability of the joint was assessed. Results Thirteen patients were followed up with 2 in loss. The average follow-up was 4 years. The pain at the metacarpophalangeal joint disappeared after operation. The active range of motion in metacarpophalangeal joint was 40° -82°(average 58. 5°), with an average increase of 46°(35°-58°) when compared with those before operation. The patients all went to the original job. Conclusion The arthropiasty with autogenous rib perichondrium transplantation is an efficient and practical method for reconstruction of the metaracrpophalangeal joint. 5 refs.

Unusual combined fracture dislocation of the wrist and metacarpophalangeal joints： a case report and review of the literature

Volar perilunate fracture dislocation is an extremely rare carpal injury, but associated with metacarpophalangeal joint dislocation of both the ipsilateral index and middle finger has never been reported. We report one case of a 28-year-old man following a high-energy trauma. After performing closed reduction of the metacarpophalangeal joint injury, open reduction of the wrist injury through volar approach was done, and a K-wire fixation was used to stabilize the scaphoid fracture and lunotriquetral joint. After a 16 months＇ follow-up period, the wrist regained a full range of motion without symptoms, and the fractured bone was strengthened in a good position.

Simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint of the thumb： A case report

Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.

Triggering,clicking,locking and crepitus of the finger:A comprehensive overview

Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.

Precise Microdeletion Detection of Prader-Willi Syndrome with Array Comparative Genome Hybridization

Objective Prader-Willi Sydrome （PWS） is a human disorder related to genomic imprinting defect on 15ql 1-13. It is characterized by a series of classic features such as hypotonia, hyperphagia, obesity, osteoporosis, typical facial and body dysmorphosis, hypogonadism, mental and behaviour disorders. Our study was designed to precisely detect the microdeletions, which accounts for 65%-70% of the PWS. Methods Physical and laboratory examinations were firstly performed to diagnose PWS clinically, and to discover novel clinical features. Then the patient was screened with bisulfite-specific sequencing and precisely delineated through high-density array CGH. Results With the bisulfite-specific sequencing, the detected CpG island in the PWS critical region was found homozygously hypermethylated. Then with array CGH, a 2.22 Mb type II microdeletion was detected, covering a region from MKRN3, MAGEL2, NDN, PWRN2, PWRN1, Cl2orf2, SNURF-SNRPN, C/D snoRNAs, to distal of UBE3A. Conclusions Array CGH, after the fast screening of Bisulfite-specific sequencing, is a feasible and precise method to detect microdeletions in PWS patients. A novel feature of metacarpophalangeal joint rigidity was also presented, which is the first time reported in PWS.

Septic arthritis of the hand:Current issues of etiology,pathogenesis,diagnosis,treatment

Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger.They rank second in the frequency of occurrence after lesions of the knee joint.Many points concerning the etiology,the timing of the development of cartilage destruction and the development of osteomyelitis,approaches to surgical treatment,the duration of antibiotic therapy,and the start of rehabilitation measures remain the subject of numerous discussions.Based on a search in the PubMed,Web of Science and Google Scholar databases down to 1990-2021,publications on septic arthritis of the hand were found and analyzed.The following inclusion criteria were used in our review:(1) Septic arthritis of the hand;(2) Published in a peer review journal;(3) Written in English;and(4) Full text version available.Studies were excluded if they met any of the following criteria:(1) Letters;(2) Articles published in abstract form only;and(3) Cadaveric studies.Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers(> 50% of cases).Up to 90% of cases,the infection enters the joint as a result of penetrating trauma,animal bites,etc.Staphylococcus aureus became the most frequently isolated microorganism(30%-55%),and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found,according to various sources,from 0% to 73% among all isolated Staphylococcus aureus.In arthritis,Pasteurella multocida(6%-11%) is often isolated as a result of animal bites.Articular cartilage destruction in the experiment developed within 24-48 h after infection.In clinical studies,the development of osteomyelitis was noted when treatment was delayed by more than 10 d.X-ray data during the first two weeks were uninformative.Priority of surgical treatment of septic arthritis.Drainage and surgical treatment,and with the development of osteomyelitis,the implementation of arthrodesis.Antibacterial therapy for 2-4 wk and early start of rehabilitation measures.Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.

A Novel Design of a Metacarpal/MetatarsaI-Phalangeal Total Joint Replacement

Arthritis, most notably rheumatoid arthritis, can destroy the surfaces of the bones; the ideal solution for this is T JR （total joint replacement）, which would restore joint functionality, maintain correct aesthetics and eradicate pain for the patient. Current metacarpophalangeal TJR do not provide the normal biomechanical range of motion and functionality. The proposed design attempts to correct this through the use of design geometry and functional anatomy. Numerical analysis is used in conjunction with computational solid modeling to compare a one-piece silicone implant with the proposed T JR. Peak stresses during flexion for the proposed design did not exceed 1.2 MPa, where as soft implants approach 100 MPa to 1,000 MPa for peak stress values. The proposed design, due to high stress tolerances with low deformation, along with functionality and biomechanics, seems to be an appropriate replacement for one-piece silicone implant.